While it is clear that smoking rates are higher among disadvantaged than among advantaged groups in Australia, researchers have also sought to examine whether disparities have been widening. The extent of disparities appears to vary over time, as well as depend on the indicator of disadvantage (e.g., education level, vs. socioeconomic status, vs. type of employment) and the sex of the smoker.

Population-wide tobacco-control strategies that reduce smoking at a similar rate of decline in low and high education groups may still (mathematically) result in increasing disparities. Some experts argue that disparity research should focus on maximising reductions in the most disadvantaged group, rather than reducing disparities per se.1

The following sections present data on trends since 1980 in disparities in smoking among adults and children. In sum, the prevalence of smoking has generally declined over time among all disadvantaged groups, regardless of the indicator. Looking at Socio-Economic Indexes for Areas (SEIFA, which comprises relative socioeconomic advantage/disadvantage, based on factors including education, occupation, and economic resources) the absolute gap in smoking prevalence between the most and least disadvantaged stayed fairly constant for the decade 2004–2013 at about 14%, before narrowing to about 12% in 2016. Some individual-level measures, however, indicate widening.

See below for prevalence over time by education level, occupation level, and SEIFA, as well as information on trends in disparities over time in cessation, consumption, and exposure to secondhand smoke.

9.2.1 Changes in the prevalence of smoking among adults in various socio-economic groups

Trends over time in smoking prevalence among different social groups can be difficult to interpret because of changing social and economic conditions. With increasing school retention in Australia and introduction of financial assistance for tertiary students in the mid-1970s, a much more diverse group of people today are achieving higher levels of formal educational qualification compared with people who undertook tertiary education in the late 1960s and early 1970s. In 2017, 27% of Australians had a university degree, compared with 7% in 1982.2

In a period of low unemployment and a buoyant job market, the unemployed in the mid-2000s on the other hand may be less socially diverse than groups who were unemployed during times of low job vacancies in the 1980s and 1990s. Towards the end of the last decade, the unemployment rate had steadily declined to 4.2% (in 2008); however, as a result of the global financial crisis in the latter part of 2008, unemployment in Australia rose to 5.6% in 2009.3 In 2017, the unemployment rate was about the same at 5.5%.4

Rates of school retention have increased substantially over time.5 Thus, any widening in the smoking prevalence gap between those who have and have not completed Year 12 could be partly attributable to early school leavers becoming a group increasingly characterised by social and economic disadvantage. The proportion of young people continuing education through to Year 12 has increased from 45% in 1984 to 84% in 2016.6

Inconsistencies in methods of collecting data and in SES categories over time make long-term analysis difficult. To get a reliable picture of trends in SES-related disparities in smoking, it is therefore useful to look at relative changes across several socio-economic indicators and using several different data sets.

9.2.1.1 Trends over time in smoking and socioeconomic status

Figure 9.2.1 shows the prevalence of regular smoking by SEIFA quintiles from 2001 to 2016 using data from the National Drug Strategy Household Surveys. Over this period, regular smoking declined linearly among all quintiles (controlling for age and sex), and encouragingly for the most recent period of 2013–16, the greatest (and only significant) reduction in prevalence occurred among the most disadvantaged smokers. Overall, the absolute gap in smoking prevalence between the most and least disadvantaged stayed fairly constant for the decade 2004–2013 at about 14%, before narrowing to about 12% in 2016.

Figure 9.2.1
Prevalence of regular* smokers† in Australia, persons 18 years and over, 2001 to 2016‡, by socio-economic index for area

* Includes those reporting that they smoke ‘daily’ or ‘at least weekly’.† Includes persons smoking any combination of cigarettes, pipes or cigars.
‡ All data weighted to the Australian population appropriate for each survey year and may vary slightly from data presented in previous edition.
Source: Centre for Behavioural Research in Cancer analysis of National Drug Strategy Household Survey data from 2001 to 2016.
The data are grouped in quintiles calculated using one of the socio-economic indexes for areas (SEIFA) developed by the Australian Bureau of Statistics. The ABS’s Index of Advantage/Disadvantage is based on a continuum of advantage to disadvantage.

Among both men and women, there was a significant linear decline in smoking prevalence among all quintiles (controlling for age; see Figures 9.2.2 and 9.2.3).

Figure 9.2.2
Prevalence of regular* smokers† in Australia, males 18 years and over, 2001 to 2016‡, by socio-economic index for area

Source and notes: See Figure 9.2.1

Figure 9.2.3
Prevalence of regular* smokers† in Australia, females 18 years and over, 2001 to 2016‡, by socio-economic index for area

Source and notes: See Figure 9.2.1

9.2.1.2 Trends over time in smoking and formal education

Increasing education levels are associated with decreased likelihood of smoking. Figure 9.2.4 sets out the prevalence of current smoking among people with various levels of education between 1980 and 2016 using data collected in surveys conducted by the Anti-Cancer Council of Victoria (ACCV; now Cancer Council Victoria) until 1998, and the National Drug Strategy Household Survey (NDSHS) from 1998 to 2016.

As is evident from Figure 9.2.1, the decline in prevalence of smoking for the total 36-year period covered by these surveys was greatest among those with a university-level education, but was also substantial among all other groups. Analysis of data from the NDSHS shows that for each of the survey years 2001 to 2016, those with a tertiary (university) level education had significantly lower levels of smoking than all other education groups (controlling for sex and age). There has been a significant linear decline in regular smoking within each education group over time (controlling for age and sex). Between 2013 and 2016, smoking prevalence declined significantly only among those who had attended university.

* Anti-Cancer Council of Victoria (ACCV) data includes those describing themselves as ‘current smokers’ with no frequency specified; National Drug Strategy Household Survey (NDSHS) data includes those reporting that they smoke ‘daily’ or ‘at least weekly’. Note that in the 1998 NDSHS, secondary school education attainment was asked in a different format to 2001 onwards.†Includes persons smoking any combination of cigarettes, pipes or cigars‡ Anti-Cancer Council data weighted to 2001 census population data, standardised by age and sex; NDSHS survey data weighted to the Australian population appropriate for each survey year and is not standardisedSource: Hill and Gray 1982,61984,7Hill 1988,8Hill, White and Gray 1991,9Hill and White 1995,10Hill, White and Scollo 1998,11and Centre for Behavioural Research in Cancer, analysis of data from the National Drug Strategy Household Survey since 1998

Table 9.2.1 shows these trends over time for men and women. In 2001, smoking prevalence was significantly higher among men than women of all education levels (controlling for age), and this pattern remained in 2016.

Table 9.2.1
Prevalence of regular* smoking† among Australian adults (18+ years) by educational level and sex—2001 to 2016‡

Note: Certificates III-IV have replaced the previous system of trade certificates* Smoked daily or weekly† Includes persons smoking any combination of cigarettes, pipes or cigars‡ All data weighted to the appropriate Australian population and may vary slightly from data presented in previous edition.Source: Centre for Behavioural Research in Cancer, analysis of data from the National Drug Strategy Household Surveys since 2001

A person’s age also plays an important role in the relationship between smoking prevalence and education level. As the proportion of Australians completing high school to the end of Year 12 and those attaining post-school qualifications have increased over time,2,6it is likely that higher educational achievement rates have contributed to the overall decline in smoking among the Australian population.

As shown in table 9.2.2, smoking prevalence has significantly declined over time among young adults (18–39 years) within each education group (controlling for gender). Among middle-aged people (40–59 years), prevalence declined among those with year 12 or higher, but not among those who did not complete high school, and among the oldest age group (60+) there has only been a decline in smoking among those with the highest level of education.

In 2016, within the oldest age group, there were no differences between those who did or did not finish high school—smoking levels were only significantly lower among those who attended university. Finishing year 12 becomes increasingly important for adults under 60 years in terms of smoking prevalence, which is likely because younger adults who have not attained year 12 reflect a far more disadvantaged group7than the oldest age group, who completed their education when leaving school early was much more common.8Within both younger age groups, those who did not complete year 12 were significantly more likely to be regular smokers in 2016. Those aged 18–39 who had not finished high school were almost twice as likely to smoke than those who had attained year 12 or equivalent and about five times more likely to smoke than those with a university-level education (adjusting for gender).

Table 9.2.2
Prevalence of regular* smoking† among Australian adults (18+ years) by educational level and age group—2001 to 2016‡

Note: Certificates III-IV have replaced the previous system of trade certificates* Smoked daily or weekly
† Includes persons smoking any combination of cigarettes, pipes or cigars
‡ All data weighted to the appropriate Australian population and may vary slightly from data presented in previous edition.
Source: Centre for Behavioural Research in Cancer, analysis of data from the National Drug Strategy Household Surveys since 2001

9.2.1.3 Trends over time in smoking and employment status

A person’s employment status is strongly related to their overall health. In general, people who are unemployed experience poorer health and have higher mortality rates than those who are employed.9As shown in figure 9.2.5, regular smoking has significantly declined over time within all employment status groups (controlling for age and gender). Unemployed individuals had significantly higher levels of regular smoking in each of the survey years than people who were employed, students, retired, or solely engaged in home duties. For the most recent period of 2013 to 2016, there was only significant decline in regular smoking among students (with no significant changes among the other groups).

* Smoked daily or weekly† Includes persons smoking any combination of cigarettes, pipes or cigars
‡ All data weighted to the Australian population appropriate for each survey year and may vary slightly from data presented in previous edition
Source: Centre for Behavioural Research in Cancer, analysis of data from the National Drug Strategy Household Surveys since 2001

9.2.1.4 Trends over time in smoking and occupation level (blue vs. white collar)

Smoking behaviour among those who are employed is also stratified by occupational level, with a decreased likelihood of smoking associated with white-collar occupation. Figure 9.2.6 sets out smoking prevalence between 1980 and 2016 for all occupational levels using ACCV data (1980–1998) and NDSHS data (1998–2016) for adults aged 18 years and over.

The decline in prevalence of smoking has been substantial across groups. The declines were proportionately greater among white collar workers than blue collar workers; overall, prevalence of smoking among upper white collar workers declined by about 70%, while among lower blue collar workers, prevalence dropped by about 45%.

Smoking rates over the 1980s and early 1990s declined roughly equally in absolute terms among these occupational groups. Disparities appear to have widened briefly in the mid-1990s before the downward trend in smoking resumed in all four occupational groups. Between 1998 and 2016, regular smoking declined linearly among all occupation levels (controlling for age and sex); although in the most recent period of 2013–16, there were no significant changes in smoking prevalence

Reflecting prior years, in 2016 smoking prevalence among upper white collar workers was significantly lower than for any other occupational group. In 2016, only 10% of individuals in upper white collar employment were smokers, compared with 28% of those working in lower blue collar employment, 19% of upper blue collar workers, and 15% of lower white collar workers.

Table 9.2.3 shows trends in smoking prevalence by occupation level and gender between 2001 and 2016. In 2001, there were no differences in smoking prevalence between males and females within any occupation group. In 2016, differences were observed among upper white and lower blue collar workers, where males were more likely than females to be regular smokers.

Table 9.2.3
Prevalence of regular* smoking† by occupational level and sex among employed Australian adults (aged 18+ years)—2001 to 2016‡

Upper white collar: includes professionals, business owners, executives, farm owners, semi-professionalsLower white collar: includes sales, other white collarUpper blue collar: includes skilled workersLower blue collar: includes semi-skilled, unskilled, farm workers.Note: classifications changed in 2010 such that some occupations that would have been classed as Upper Blue in 2007 may be classified as Lower Blue in 2010. Tradepersons are classified as Upper Blue in 2010 but would have been classified as Lower White in previous years. For more information see the ABS website.10* Smoked daily or weekly† Includes persons smoking any combination of cigarettes, pipes or cigars‡ All data weighted to the appropriate Australian population and may vary slightly from data presented in previous editionSource: Centre for Behavioural Research in Cancer, analysis of data from the National Drug Strategy Household Surveys since 2001

9.2.2 Differential uptake or differential cessation?

In the general population, smoking prevalence has reduced due to a combination of fewer people taking up smoking, more people quitting, and more smokers than non-smokers dying prematurely. Figure 9.2.7 shows the proportion of persons who identified as never smokers, across SEIFA quintiles between 2001 and 2016.

Figure 9.2.7
Percentage never smokers in Australia, persons 18 years and over, 2001 to 2016‡, by socio-economic index for area

‡ All data weighted to the Australian population appropriate for each survey year and may vary slightly from data presented in previous edition.Source: Centre for Behavioural Research in Cancer analysis of National Drug Strategy Household Survey data from 2001 to 2013.The data are grouped in quintiles calculated using one of the socio-economic indexes for areas (SEIFA) developed by the Australian Bureau of Statistics. The ABS’s Index of Advantage/Disadvantage is based on a continuum of advantage to disadvantage.

The proportion of never smokers in the most disadvantaged group was 45% in 2001 and 56% in 2016. In comparison, almost 53% of those in the least disadvantaged group were never smokers in 2001 and this increased to about 65% by 2016. Since 2001, there has been a significant linear increase in the proportion of never smokers within each quintile (controlling for age and sex), and between 2013 and 2016 there was a significant increase among the most and least disadvantaged (1st and 5th quintiles), and the 3rd quintile.

The proportion of men identifying as never smokers significantly increased between 2001 and 2016, across all quintiles (controlling for age; see Figure 9.2.8). In the most recent period of 2013 to 2016, the proportion of never smokers only increased among the 3rd and 5th (most advantaged) quintiles.

Figure 9.2.8Percentage never smokers in Australia, males 18 years and over, 2001 to 2013‡, by socio-economic index for area

Source and notes: see Figure 9.2.6

Figure 9.2.9 shows the proportion of women who identified as never smokers, across SEIFA quintiles between 2001 and 2013. Proportions of never smoking women have significantly increased since 2001 across all quintiles (controlling for age). The gap between quintiles has generally been smaller than in men, although in contrast to men, has narrowed in recent years; the only significant increase in never smokers between 2013 and 2016 was among the most disadvantaged women. Overall, it appears that fewer disadvantaged women, and fewer advantaged men, are taking up smoking.

Figure 9.2.9
Percentage never smokers in Australia, females 18 years and over, 2001 to 2016‡, by socio-economic index for area

Source and notes: see Figure 9.2.6

Figure 9.2.10 shows quit proportions (i.e., the proportion of ever smokers who have quit) among adults across SEIFA quintiles. While the proportion of adults quitting smoking since 2001 has significantly increased among the second through fifth quintiles, there has been a significant linear decrease in quit proportions among the most disadvantaged smokers (controlling for age and sex).

Figure 9.2.10
Percentage of ever smokers who have quit in Australia, persons 18 years and over, 2001 to 2016, by socio-economic index for area

Source and notes: see Figure 9.2.6

Figure 9.2.11 shows quit proportions among men by SEIFA quintiles. There has been a significant increase in the proportion of men who have quit only among the least disadvantaged group, while there has been a significant decrease in the proportion of the most disadvantaged men quitting (controlling for age). The data indicate a growing differential between the most disadvantaged and least disadvantaged socio-economic groups.

Figure 9.2.11
Percentage of ever smokers who have quit in Australia, males 18 years and over, 2001 to 2016‡, by socio-economic index for area

Source and notes: see Figure 9.2.6

Figure 9.2.12 shows quitting proportions among women by SEIFA quintile. There has been no significant change over time in quit proportions among the most disadvantaged women, while there has been a significant increase among each of the other quintiles (controlling for age). As with males, the higher proportion of quitters in the more advantaged groups has led to an overall widening of the gap; although this narrowed by about 7% between 2013 and 2016.

Figure 9.2.12
Percentage of ever smokers who have quit in Australia, females 18 years and over, 2001 to 2016‡, by socio-economic index for area

Source and notes: see Figure 9.2.6

Earlier research in Victoria, on the other hand, found significant increases in the proportions of regular smokers who had ever made a quit attempt in the low and mid socio-economic groups, but not in the least disadvantaged group. Between the years 2004 and 2010, a significant increase in the proportion of successful quit attempts (in the five years preceding the 2010 survey) was reported for Victorians in the most disadvantaged socio-economic group.11

9.2.3 Changes in consumption of cigarettes

9.2.3.1 Trends over time in consumption and socioeconomic status

Figure 9.2.14 shows average consumption over time by SEIFA quintile. Since 2001, there has been a significant linear decline in consumption among all quintiles (controlling for age and sex); however, there were no changes between the most recent two survey years.

9.2.3.2 Trends over time in consumption and formal education

People with higher education levels are less likely to be smokers. In addition, among those who do smoke, increasing education levels are also associated with decreased consumption. Since 2001, average daily consumption has decreased among all education levels (controlling for age and sex), although there were no changes between the two most recent survey years. In 2016, consumption was significantly lower among those with a university education than among those who had completed year 12, year 10/11, and up to year 9 (controlling for age and sex).

* Smoked daily or weekly† Includes persons smoking factory made cigarettes and/or roll-you-own‡ All data weighted to the Australian population appropriate for each survey year and may vary slightly from data presented in previous editionSource: Centre for Behavioural Research in Cancer, analysis of data from the National Drug Strategy Household Surveys 2001–201612-17‡

9.2.3.3 Trends over time in consumption and employment status

Although people who are retired are less likely to smoke (see Section 1.7), those who do smoke appear to consume the greatest number of cigarettes per day. Nonetheless, consumption has declined among people of all employment statuses since 2001 (controlling for age and sex), although remained stable in recent years. Figure 2.3.9 shows these trends over time.

* Smoked daily or weekly† Includes persons smoking factory made cigarettes and/or roll-you-own‡ All data weighted to the Australian population appropriate for each survey year and may vary slightly from data presented in previous editionSource: Centre for Behavioural Research in Cancer, analysis of data from the National Drug Strategy Household Surveys 2001–201612-17‡

9.2.3.4 Trends over time in consumption and occupation level

Among people who are employed, consumption differs by occupation level. People in blue collar occupations are more likely to smoke (see Section 9.1), and to smoke more heavily than people in white collar occupations.

Figure 9.2.13 illustrates consumption levels among smokers of varying occupational levels between 1980 and 2016 using ACCV data (1980–1998) and NDSHS data (2001–2016). Analysis of NDSHS data from 2001 onward shows that average consumption significantly declined in all occupation groups (controlling for age and sex). Between 2013 and 2016, there was a significant decline in consumption among lower white collar workers, and a trend toward a decline among lower blue collar workers.

* Anti-Cancer Council of Victoria (ACCV) data includes those describing themselves as ‘current smokers’ of factory made cigarettes with no frequency specified; National Drug Strategy Household Survey (NDSHS) data includes those reporting that they smoke factory made and/or roll your own ‘daily’ or ‘at least weekly’. †Includes persons smoking any combination of cigarettes, pipes or cigars‡ Anti-Cancer Council data weighted to 2001 census population data, standardised by age and sex; NDSHS survey data weighted to the Australian population appropriate for each survey year and is not standardisedSource: Hill and Gray 1982,61984,7Hill 1988,8Hill, White and Gray 1991,9Hill and White 1995,10Hill, White and Scollo 1998,11and Centre for Behavioural Research in Cancer, analysis of data from the National Drug Strategy Household Survey since 2001

9.2.4 Changes in the prevalence of smoking among students in schools in areas of varying levels of disadvantage

Higher levels of uptake among disadvantaged groups have traditionally been even more significant than lower levels of cessation as a driver of socio-economic disparities in smoking in Australia. Data on smoking rates among secondary school students of different socio-economic backgrounds can provide an indication of what future smoking disparities may look like.

Figures 9.2.17 and 9.2.18 show weekly smoking rates among young people aged 16 and 17 years and 12–15 years between 1987 and 2014 according to the level of disadvantage of the neighbourhood in which they lived.

Figure 9.2.17
Reported current smoking (smoking in the last week), secondary students in Australia aged 16 and 17 years, 1987–2014, ranked by quartiles of advantage by the area in which the student lived

Declines in student smoking rates have been substantial across all quartiles since the late nineties and early 2000s. For the first half of the 2000s, smoking rates appear to follow a social gradient, with the lowest proportion of smokers in the least disadvantaged group. Since then, there is no clear pattern of smoking by socioeconomic status among students aged 16 and 17 years.

Figure 9.2.18
Reported current smoking (smoking in the last week), secondary students in Australia aged 12–15 years, 1987–2014, ranked by quartiles of advantage by the area in which the student lived

Among students aged 12–15 years, following a sharp increase in prevalence among the lowest SES students between 1990 and 1996, smoking appears to decline roughly equally among students at all levels of disadvantage until 2005. Recent years have seen smoking rates converge among this age group, with 3% of students in each of the quartiles reporting weekly smoking in 2014.

9.2.5 Changes in childhood exposure to smoking in the household

The disparity in children living with a smoker has widened over time; in 2001, about the same proportion of the most disadvantaged households with a dependent child contained a smoker (51%) as 2016 (44%), while among the least disadvantaged households, there were far more households with a smoker in 2001 (32%) than reported in the most recent survey (19%).

In contrast, the percentage of households with dependent children that also allow smoking indoors has decreased substantially since 2001 in all SEIFAs, but more so among disadvantaged groups, leading to a narrowing of the gap (see Table 9.2.4). The difference in smokefree households between the most and least disadvantaged groups was only about 7% in 2016, compared with 16% in 2001 (and 23% in 2004).

In 2016, 86% of the most disadvantaged households with dependent children and at least one smoker reported keeping their home smokefree (that is, the smoker (or smokers) smoked only outdoors). The proportion of outdoor-only smoking in this group rose by about 35% from 2001. In 2016, in 93% of the least disadvantaged households with a smoker containing dependent children, the person/people who smoked only did so outdoors (see Table 9.2.4).

Table 9.2.4
Percentage of households with a smoker that reported only allowing smoking outdoors in the last 12 months, Australia, 2001 to 2016‡, socio-economic index for areas: households with dependent children

Source and notes: see Figure 9.2.6

9.2.6 International comparisons

Observations of smoking and its connection with socio-economic disadvantage are not confined to the Australian population. Survey data in the UK show more rapid declines in smoking among non-manual workers compared with manual workers since the 1970s, contributing to a widening of smoking prevalence between these groups. Smoking was nearly twice as common in routine and manual households as in managerial and professional households (28% compared to 15%). Smoking prevalence was particularly high among economically inactive people aged 16–59 years, whose last job was a routine or manual one; 50% of these people were smokers.29

Observations on growing socioeconomic differences in smoking have also been made in research from Finland,30New Zealand,31Italy,32,33the US, and Canada34-36and France.37

Similar to the picture in Australia, research in England between 1996 and 2006 found that children from more deprived households were most exposed to secondhand smoke, however across the 11-year research period exposure declined substantially. The most marked declines were observed immediately before the introduction of smokefree legislation in England and among children who were most exposed at the outset.38Similarly, several studies in the US have found that, despite some ongoing socioeconomic disparities, children’s exposure to secondhand smoke at home has markedly decreased over time.39,40

Relevant news and research

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11. Centre for Behavioural Research in Cancer. Current and former smokers' quitting activity and intentions: Findings from the 1998−2010 Victorian smoking and health surveys, unpublished data. Melbourne, Australia: CBRC, 2011.

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34. Chilcoat HD. An overview of the emergence of disparities in smoking prevalence, cessation, and adverse consequences among women. Drug and Alcohol Dependence, 2009; suppl. 1:S17−23. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19632070

35. Reid J, Hammond D, and Driezen P. Socio-economic status and smoking in Canada, 1999-2006: Has there been any progress on disparities in tobacco use? Canadian Journal of Public Health, 2010; 101(1):73–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20364543

36. Smith P, Frank J, and Mustard C. Trends in educational inequalities in smoking and physical activity in Canada: 1974 to 2005. Journal of Epidemiology and Community Health, 2009; 63(4):317–23. Available from: http://jech.bmj.com/content/63/4/317.long

37. Peretti-Watel P, Constance J, Seror V, and Beck F. Cigarettes and social differentiation in France: Is tobacco use increasingly concentrated among the poor? Addiction, 2009; 104(10):1718–28. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19681803